A shocking waste of medicine
On April 1, the National Health Insurance Administration (NHIA) once again adjusted the price of medicine administered under the National Health Insurance (NHI) system. This seems to be the routine way to resolve the NHIA’s prescription budget black hole.
When I visited an old friend during Lunar New Year, he took out a large bag of medicines and asked me what to do with it. All of them were less than one year old and some had not even been opened.
Throwing away perfectly good medication seemed odd. I asked why he had not taken the medicine. He replied that, as his blood pressure is normal, why should he take the medicine, and proceeded to tell me about his bad experience seeing his doctor.
My friend has a history of high blood pressure, high cholesterol and high triglyceride levels, and regularly goes to a hospital for a checkup and to pick up a prescription for his chronic illness to keep his condition under control.
One year ago he retired and began to watch his diet and do exercise. He also started measuring his blood pressure every morning, noon and evening, and his blood pressure is normal and he feels in great shape, so he stopped taking his medication.
I reminded him that he should not arbitrarily alter the dosage or stop taking the medicine and that even if the symptoms have stabilized, he should let his doctor decide.
He said he had told the doctor when he went for a checkup, but his doctor is a “famous doctor” who sees more than 100 patients each day.
Appointments are very short, so he hardly had time to say more than a few words and before he could show the doctor his blood pressure record card, which he had been meticulously keeping, the nurse was calling the next patient while he was still inside the examination room.
When he picked up his prescription, it was exactly the same as before. The doctor had simply copied the previous prescription. Puzzled, my friend asked me why doctors always have to prescribe medication?
This is probably a common question, but has the NHIA attempted to understand the underlying causes of the problem? One problem facing the current system is a lack of joined-up communication during the treatment of patients.
My friend was given a new generation of an extremely expensive brand-name blood pressure-lowering drug that is covered under the NHI system. When I saw the shining anti-counterfeit label on the discarded medicine boxes, the irony was not lost on me.
These labels were added following a counterfeit drug scandal last year involving a lipid-lowering drug, consignments of which were found to contain counterfeit drugs.
Both the manufacturer and prescribing physicians must have thought to themselves: If patients are not taking the medicine, what is the harm in giving them the counterfeit version over the genuine article?
Annual NHIA expenditure on medication exceeds NT$160 billion (US$5.45 billion), while NT$40 billion of medication — 40 percent — is discarded or reclaimed every year. What a shocking waste. If this money were spent on cancer treatments, acute medical illnesses and long-term care, think how many patients would benefit.
Money should be spent where it counts and medication should be prescribed to treat an illness; the NHIA knows this better than anyone. However, as we reach the 23rd anniversary of the NHI, waste is omnipresent, and medication is surely the biggest drain on finances.
The NHIA must rethink matters: Adjusting medicine prices is just a sticking-plaster solution. It must tackle the problem at the source to root out waste.
Tsai Ming-tsan
Tainan
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